Sitters, give 'em a break!

cardiacRN2006, ADN, RN · Nov 22, 2006

Wow.....wouldn't have worked with me. I would have told you to take it up with the house supe. Ultimatums are fastest way to get me to do only what is necessary for you, the sitter. If you asked me to try and break you every couple of hours I would tell you that I would try, but if I'm too busy to take a break then it means I'm too busy to break you that often. And I would flat out refuse to give you 45 minutes under any circumstances. I have a whole world of respect for sitters and will do what I can to help, because you're right, it's a tough job. But I don't do ultimatums.

ITA! I certainly don't get even close to 10 min breaks q2hrs myself! I'm lucky if I get to urinate twice a day, so I certainly don't have the time to break someone else every 2 hours-especially if they are demanding it. Last week I went to the bathroom AND ate lunch in about 3 minutes.

I used to sit as a PCT. We didn't have outside sitters. If a pt needed a sitter, then it was one of us who did it. About 99% of the time it meant for great studying or tv watching. I never had a problem asking the other techs to relieve me to go to the bathroom (I didn't take 10 minutes either). But as a tech I also had to bathe them, take vitals on them, assist them to the bathroom, and yes, actually touch the pt to maintain their safety.

caroladybelle, BSN, RN · Nov 23, 2006

You want to know why you're complaining that the world is ending because you have to take your own vitals? Because your aides are sitting.
You want to know why your aides are sitting? 'Cause your sitters quit.
'Cause nobody took 10 minutes out of every 2 hours to let 'em pee/smoke/get a Coke.
'Cause they know if they don't get those 10 minutes every 2 hours esp. 7p to 7a they're gonna fall asleep and get fired.
'Cause the RN couldn't be bothered to call the doctor to get an order for Haldol PRN, or for effective pain meds, or to order restraints when it was really, really needed. Or couldn't be bothered to give PRNs that *were* ordered.

A couple of points:

I don't get 10 minutes every 2 hours to pee or smoke or have a soda. I am doing good to get 10 minutes during 12 hours to eat anything, myself.

And if the patient has a sitter, it is generally because the MD does not want them to have Haldol or restraints. Otherwise we could eliminate the use of sitters entirely.

There are laws against using Haldol/restraints for the convenience of the staff. And MDs that order Haldol/restraints frequently will find JCAHO and other regulatory depts all over his/her practice.

It is a staff member's duty to bring food/hygiene products for their needs. Why an aide would need to buy a Popeye's sandwich for someone - that has tp do with the sitter's poor planning, not the nurse's need to provide for them.

Quite frankly, I have no problem that aides sit. Given the attitude, I am more than happy to do my own vitals...especially since it invariably takes more time/effort to get the aide to do his/her job than to do it myself.

But then I usually work primary care... something I prefer. And reading posts like this reminds me why I prefer primary care.

PANurseRN1 · Nov 23, 2006

Sorry, I was in a rush and didn't explain. On this one floor, the charge who had this pt won't give PRN Haldol AT ALL. This was explained to me by a floor RN when I had a very combative pt who was determined to go home. The poor pt ended up fighting restraints all night.
Now my collar's getting tight. I hate restraints. Nothing is guaranteed to generate anxiety faster than tying someone down. I'd say 90% of the time I get report that a pt is "bad" I just go in the room and first thing I do is undo the restraints and we start talking and everything is fine.
Some folks assume pts want to be "bad." Pts hate being confused. They hate hallucinating. They hate being tied down. I despise it when folks ask pts "Now are you going to be good tonight?" because the pt doesn't *want* to be "bad," he doesn't even have any control over it!

If you took restraints off my pt. without asking me first, I would make sure your work day ended right then and there. You are way out of bounds if you do that. I'm surprised no one has called you on it already.

PANurseRN1 · Nov 23, 2006

I'm not sure that you can legally do this - put patients in and out of restraints on one order. That would be a PRN order for restraints. It's my understanding that JACHO requirements are that a restraint order be written for a specific type of restraint and a specific length of time. True, that order can be dc'd early, but then if the patient needs to go back into restraints, a new order needs to be written. That's what we do where I am. If I don't have this right, does anyone have clarification?

You are correct. In my state, once those restraints come off you need a new order to put them back on...there's no such thing as "prn" restraints. So I would be furious to find out a sitter was taking restraints off an putting them back on again at his/her discretion.

jojotoo, RN · Nov 23, 2006

Our orders are for 24hrs. So I can take them off and put them on as many times as I want within the those 24hrs. Otherwise, people wouldn't want to take restraints off because they wouldn't want to have to re-initiate a new restraint order.

We have two kinds of restraints: hard restraints (leather) which can only be used in the ER, ICU, BHU and soft restraints (cloth) that can be used anywhere in the hospital. Hard restraints are for patients with behavioral problems and are used to either protect the staff or the patient from himself. These restraints can only be ordered for 4 hours at a time and they must be checked q 15min for as long as the patient is in them. The soft restraints (and this includes a posey) are considered non-behavioral and are what we use for intubated patients,demented patients, mainly to keep the pt from pulling out tubes or lines. These can be ordered for up to 24 hours and the pt only needs to be checked q 1hr.

Hellllllo Nurse, BSN, RN · Nov 23, 2006

You want to know why you're complaining that the world is ending because you have to take your own vitals? Because your aides are sitting.
You want to know why your aides are sitting? 'Cause your sitters quit.
You want to know why they quit?
'Cause nobody took 10 minutes out of every 2 hours to let 'em pee/smoke/get a Coke.
'Cause they know if they don't get those 10 minutes every 2 hours esp. 7p to 7a they're gonna fall asleep and get fired.
'Cause they were PRN aides who didn't offer to do a 12-hour shift sitting, they just got grabbed and whereas they could keep themselves awake running around the floor all night, they aren't physically prepared to stay in one darkened room all night without breaks and not nod off.
You can't get them to come back because they quit working PRN and went dedicated labor pool in a unit that doesn't use sitters.
'Cause the RN couldn't be bothered to call the doctor to get an order for Haldol PRN, or for effective pain meds, or to order restraints when it was really, really needed. Or couldn't be bothered to give PRNs that *were* ordered.
You know one night I got tired of watching all the RNs drinking coffee and complaining in full view of a sitter who hadn't had a break for 4 hours. I ran and bought her a Popeye's fried chicken dinner. Me, on $7.50 an hour.
2 nights ago for the first time after a hundred sitting jobs, I had a kindly old RN give me 2 breaks Q2H, told me to take my time, and guess what she did, she charted, no skin whatsoever off her nose.
Compare that to the countless times I really needed some help or supplies in the room and had the call bell ignored for 30 minutes or more. Or the 4+ nights I had it cancelled on me repeatedly. Repeatedly!
Got a sitter shortage? Fix it yourself. You can do it.

That is your experience. My experience with sitters is quite different.

JoeyDog · Nov 23, 2006

When I worked as the primary sitter on a MSICU floor I usually only got a 30 min. lunch break. When ever the nurse came in to do an assessment or hang meds or do a dressing change or whatever I would ask if I could use the bathroom. They never had a problem with that. It worked fine for me and for the nurses that I worked with. I never complained about not getting potty breaks b/c I took them whenever the nurse or RT came in to do something.

I understand why so many nurses dislike the sitters though. I have worked with so many that really were bad sitters. They would keep the patient restrained, perform no patient care, and just watch TV or read their whole shift. I personally don't like TV that much so I never watched TV. But more than that I was being paid to do a job, not to watch TV or sleep. I always felt uncomfortable having the TV on unless the patient wanted it on b/c I felt like the staff would think I was one of "those" sitters.

Anyway I worked hard took wonderful care of my patients and always helped my nurse when I could. As a result I was treated well by the staff and was always given a choice in my patient assignment. My nurses were also willing to listen to any input I had, and were more willing to medicate my patient if I asked them to. They knew that I was not asking for haldol or ativan b/c I was lazy and didn't want to deal with the patient but b/c my patient was uncontrollable.

All in all I think if you work hard, do a good job, and are curteous to your nurse they will respect you and treat you a heck of a lot better!!!

Hellllllo Nurse, BSN, RN · Nov 23, 2006

When I worked as the primary sitter on a MSICU floor I usually only got a 30 min. lunch break. When ever the nurse came in to do an assessment or hang meds or do a dressing change or whatever I would ask if I could use the bathroom. They never had a problem with that. It worked fine for me and for the nurses that I worked with. I never complained about not getting potty breaks b/c I took them whenever the nurse or RT came in to do something.
I understand why so many nurses dislike the sitters though. I have worked with so many that really were bad sitters. They would keep the patient restrained, perform no patient care, and just watch TV or read their whole shift. I personally don't like TV that much so I never watched TV. But more than that I was being paid to do a job, not to watch TV or sleep. I always felt uncomfortable having the TV on unless the patient wanted it on b/c I felt like the staff would think I was one of "those" sitters.
Anyway I worked hard took wonderful care of my patients and always helped my nurse when I could. As a result I was treated well by the staff and was always given a choice in my patient assignment. My nurses were also willing to listen to any input I had, and were more willing to medicate my patient if I asked them to. They knew that I was not asking for haldol or ativan b/c I was lazy and didn't want to deal with the patient but b/c my patient was uncontrollable.
All in all I think if you work hard, do a good job, and are curteous to your nurse they will respect you and treat you a heck of a lot better!!!

joeydog, your experiences as a sitter mirror mine. I was an agency CNA/sitter at several acute care facilities from 1990-1992. I took my job seriously, and the nurses were always great to me.

As a nurse, I had one sitter who watched TV and ate Cheetos in the pt's room all noc. The pt was an elderly, demented man who'd just had an ORIF of the hip. The pt's pain seemed to be well controlled. The problem was him trying to get out of bed, insisting that nothing was wrong with him and that he was going home. Besides the fall/safety issues, I had asked the sitter to watch the pt's foley bag. I marked the urine level with a sharpy when we first went in. I told the CNA/sitter to notify me if the pt did not put out 60cc urine/hr.

I was going to be very busy with two TURP pts on CBI, a very pregnant teen with status asthmaticus, and lots of anxious family members, a s/p intracranial bleed, and a couple other pts. I knew I wouldn't be able to spend much time in the ORIF pt's room.

Later on in the noc, the sitter got annoyed with me when I lifted the pt's covers to check the pt's incision, saying "you'll wake him up!" The pt had dug out all of his staples. He was a horrible bloody mess. Not only that, the urine level in the foley bag was the same as it had been on my inital assessment earlier.

Marie_LPN, RN, LPN, RN · Nov 23, 2006

'Cause nobody took 10 minutes out of every 2 hours to let 'em pee/smoke/get a Coke.

Let's see, if i were doing 12 hr. shifts....and gave the sitter a break every 2 hours for 10 minutes...

Odds are that would be more of a break than i'd ever get on a med-surg floor.

(And yes, i've been a sitter before)

vamedic4, EMT-P · Nov 23, 2006

To the OP...you have sooo got it spot on!!! As a tech I DREAD the times when the nurses need a 1:1 sitter for a patient. There are times when I'll call out to no avail for a bathroom break, or just to tell people "hey, I've got to get up or I'm gonna fall asleep"...and usually they're pretty prompt.

Our sitter assignments are usually psych kids on the floor for medical reasons, and they have to be charted on q15 minutes...ridiculous IMO, especially since they're asleep most of the night.

And for those of you who've never had to sit with a patient for 12 hours, 8 hours..consider yourselves VERY lucky. I'd rather be busting my butt running from floor to floor to code patients, draw blood, do VS...anything but sit. Ugh.

vamedic4

working tonight

Tweety, BSN, RN · Nov 24, 2006

And for those of you who've never had to sit with a patient for 12 hours, 8 hours..consider yourselves VERY lucky. I'd rather be busting my butt running from floor to floor to code patients, draw blood, do VS...anything but sit. Ugh.
vamedic4
working tonight

No one said it was easy, and I certainly couldn't do it. I'd rather be overwhelmed with work than sit. I would go insane.

You still aren't getting 10 minute breaks q2h from me. :chuckle

Jo Dirt · Nov 24, 2006

Vamedic, if you don't like sitting why don't you do something else like CNA? Is someone twisting your arm and pressing you in that chair?